Biomedical subjects

L Portera

Publications and source records attributed to L Portera.

At least 37 records · Page 2Linked to original sources

PubMed1997

Violence by patients admitted to a private psychiatric hospital.

OBJECTIVE: The authors determined the rates and patterns of violence toward persons by psychiatric patients before admission to the inpatient service of the Payne Whitney Clinic and determined which factors were associated with a greater risk of violence. METHOD: During hospitalization, 763 patients were interviewed by a research assistant using a structured interview instrument. The interviewer inquired about demographic and socioeconomic information and about history of violence and alcohol and drug use. RESULTS: Having physically attacked another person in the month before admission was equally likely among male (13.6%) and female (14.7%) patients. The patterns of violence were similar for men and women in terms of target, severity of injuries, use of a weapon, and place of occurrence. Univariate analyses showed that only youth was associated with violence for male patients, while youth, low socioeconomic status, substance abuse, and axis II pathology were associated with a greater risk of violence for female patients. Logistic regression analyses showed that recent cocaine use was significantly associated with violence by female patients when age, socioeconomic status, and axis II pathology were controlled for. For male patients, recent heroin use was related to a greater risk of violence. CONCLUSIONS: The frequency of violence by female patients was 150% higher than it was in a study at the Payne Whitney Clinic a decade ago. The frequency of violence by male patients was 50% higher than it was a decade ago. In the current study, substance abuse was associated with greater risk of violence by patients.

Adolescent↗

PubMed1997

False positive results: a challenge for psychiatric screening in primary care.

OBJECTIVE: The goal of this study was to characterize primary care patients with false positive results on screens for mental disorders. METHOD: A sample of 1,001 primary care patients completed self-administered screens and structured interviews for DSM-IV diagnoses. RESULTS: A substantial proportion of the patients with false positive screen results for at least one diagnosis met the diagnostic criteria for other psychiatric disorders. They also had significantly greater functional impairment and higher rates of recent use of mental health services than the subjects with true negative results on the screens. CONCLUSIONS: Although the positive predictive values of screens for specific mental disorders are in line with those of other medical screens, false positive results are not uncommon. This may be due in part to the sensitivity of brief screening instruments to nonspecific symptoms. The results suggest that as with other screens used in primary care, patients with false positive results on screens for mental disorders should receive clinical attention.

Adolescent↗

PubMed1997

HIV seroprevalence among suicide victims in New York City, 1991-1993.

OBJECTIVE: The authors sought to determine the HIV seroprevalence among suicide victims in New York City. METHOD: All suicides of city residents from 1991 through 1993 were studied. The crude proportion of all suicide victims who were HIV positive and the proportion adjusted to the age, gender, and racial/ethnic characteristics of the New York City population were determined. The demographically adjusted proportion was then contrasted with HIV seroprevalence estimates for the New York City general population. HIV-seropositive suicide victims were assessed for pathological findings suggestive of HIV-related illnesses. RESULTS: The crude proportion of all suicide victims who were HIV seropositive was 0.088, and the demographically adjusted proportion was 0.049. Over 90% of all HIV-positive suicide victims were aged 25 to 54 years, and almost 90% were men. Among black and Hispanic men aged 35 to 54 years who committed suicide, the proportion who were HIV seropositive was 0.252--the highest seropositive rate of any demographic group. More than two-thirds of HIV-seropositive suicide victims had no HIV-related pathology or AIDS-indicator conditions at autopsy. CONCLUSIONS: The demographically adjusted proportion of suicide victims who were HIV positive (approximately 0.038 to 0.059), contrasted with the HIV seroprevalence estimates for the New York City general population (approximately 0.014 to 0.032), the absence of HIV-related pathology among suicide victims, and the likelihood that many HIV-positive individuals had other risk factors for suicide, such as substance abuse, suggests that a positive HIV serostatus is associated, at most, with a modest elevation in suicide risk.

Adult↗

PubMed1997

Sexual functioning in chronically depressed patients treated with SSRI antidepressants: a pilot study.

OBJECTIVE: This prospective study assessed changes in depression and sexual functioning in chronically depressed men and women during treatment with selective serotonin reuptake inhibitors (SSRIs). METHOD: Twenty-five subjects (14 women, 11 men) with DSM-III-R dysthymia, chronic major depression, or double depression were administered the Arizona Sexual Experience Scale and the Hamilton Depression Rating Scale before and after 6 weeks of treatment with sertraline or paroxetine. RESULTS: As measured by scores on the Arizona Sexual Experience Scale, desire, psychological arousal, and overall sexual functioning significantly improved in women; orgasm delay, orgasm satisfaction, and overall sexual functioning significantly worsened in men. CONCLUSIONS: This study suggests that after SSRI treatment, difficulties with desire and psychological arousal in depressed women tend to remit, whereas in men orgasmic dysfunction appears to be a side effect to medication.

Adult↗

PubMed1997

A prospective study of violence by psychiatric patients after hospital discharge.

OBJECTIVE: The study assessed the frequency of violence by patients two weeks after discharge from a psychiatric hospital and identified characteristics of patients with an increased risk of violence after discharge. METHODS: A structured form was used to interview patients aged 18 to 59 years in a private university psychiatric hospital. Patients provided self-reports of past violence, and violence while in the hospital was assessed by routine nurse ratings. Patients were telephoned two weeks after discharge to assess violence since discharge. RESULTS: Sixteen of 430 patients who were interviewed by telephone two weeks after discharge reported violence against persons since their discharge. Patients who were violent in the month before admission were nine times more likely to be violent in the two weeks after discharge, compared with patients who were not violent just before admission. Patients with a personality disorder were four times more likely than patients without a personality disorder to be violent after discharge. The targets of violence were often family members or other intimates and often the same persons attacked before hospitalization. CONCLUSIONS: Patients who were violent just before admission were more likely to be violent after discharge and to attack the same persons they had attacked in the past. Clinicians should routinely evaluate past violence and work with the patient and potential targets of violence to prevent future violence.

Adult↗

PubMed1997

Assessing psychiatric impairment in primary care with the Sheehan Disability Scale.

OBJECTIVE: Several recent studies have documented that substantial functional impairment is associated with many of the mental disorders seen in primary care. However, brief measures of mental health-related functional impairment are not commonly applied in primary care settings. The Sheehan Disability Scale (SDS), a three-item instrument for assessing such impairment, is evaluated in this study. METHOD: A psychometric analysis of the SDS was conducted with a sample of 1001 primary care patients at Kaiser Permanente In Oakland, California. The SDS and the Symptom Driven Diagnostic System for Primary Care assessments were completed. RESULTS: The internal consistency reliability of the SDS is high, with coefficient alpha of 0.89. The construct validity was substantiated in two ways. A one-factor model fit the data quite well. Furthermore, patients with each of six psychiatric disorders had significantly higher impairment scores than those who did not. Finally, over 80 percent of the patients with mental disorder diagnoses had an elevated SDS score and nearly 50 percent of those with elevated SDS scores had at least one disorder. CONCLUSIONS: The psychometric properties of the SDS were evaluated in primary care. The internal consistency reliability was high. The analyses also lend empirical support for the construct validity. The scale is a sensitive tool for identifying primary care patients with mental health-related functional impairment, who would warrant a diagnostically-oriented mental health assessment.

Adolescent↗

PubMed1997

Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < .001). This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.

Adolescent↗

PubMed1997

HIV infection among victims of accidental fatal drug overdoses in New York City.

AIMS: To determine the factors associated with HIV seroprevalence rates for victims of drug overdoses. DESIGN: Descriptive epidemiologic survey of a complete 3-year sample of accidental fatal drug overdoses. SETTING: New York City (population 7,322,564). PARTICIPANTS: All people over 15 years of age (n = 2159) who died of accidental fatal drug overdoses during 1991-93. MEASUREMENTS: Using medical examiner data and logistic regression analyses were conducted to examine the association between HIV seroprevalence and gender, race, age and type of drug overdose. FINDINGS: There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV positive. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). Victims residing in communities with higher levels of poverty had higher rates of HIV infection but poverty did not account for the high rates of HIV infection among African-Americans. The highest rates of HIV infection were found among victims aged 35-44 years (38.8%) and 45-54 years (33.7%). Dying from an opiate overdose was associated with a 2.4 times increase in the likelihood of being HIV positive. CONCLUSION: If opiate abuse continues to rise in the United States, HIV infection will increase in the next few years. Women who abuse drugs participate in risky sexual practices and are more likely than men to develop HIV infection from receptive sex as well as sharing of needles. Harm reduction programs should address risky sex as well as needle programs. There should be further study of why African-Americans who died of drug overdoses have the highest rates of HIV infection.

Adolescent↗

PubMed1997

HIV seroprevalence rates among homicide victims in New York City: 1991-1993.

This study assessed HIV seroprevalence in homicide victims killed in New York City in 1991-1993, using data from the Office of Chief Medical Examiner. Among 5852 homicide victims there were 344 (5.9%) victims who were HIV positive. Females were just as likely as males to be HIV positive. For females, the highest rates were in the 25-34 year (11.7%) and 35-44 year (12.6%) age categories. For males the highest rates were in the 35-44 year (13.7%) and 45-54 year (11.5%) age categories. Other than there being no HIV positive Asian victims, there were no differences in HIV rates among racial/ethnic groups. The highest rates of HIV infection for homicide victims were among those using both opiates and cocaine (males: 23.0%; females: 27.3%). Women, not men, using cocaine alone had a high HIV positive rate (18.4%). Victims not using these drugs had rates of HIV around 2%. The authors believe that the high risk of HIV among homicide victims, may be due to the use of cocaine and associated risky use of needles and risky sex practices.

Adolescent↗

PubMed1996

Childhood abuse and subsequent sexual assault among female inpatients.

The relationship between a history of childhood abuse and subsequent sexual assault was assessed among 409 consecutive female inpatient admissions. A total of 45% of the sample reported a history of some form of childhood abuse and 22% reported at least one adulthood sexual assault. A hierarchical logistic regression indicated that, after controlling for sociodemographic and diagnostic variables, women with a history of childhood abuse were 3.1 times more likely to have experienced an adult sexual assault compared to those without abuse. There was a higher prevalence of adult sexual assault among women reporting only physical abuse or physical and sexual abuse than those reporting only sexual abuse, indicating the significance of physical abuse as a potential risk factor for adult sexual assault.

Adolescent↗

PubMed1996

Brief screens for mental disorders in primary care.

We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [kappa] 0.63), drug dependence (SE 0.50; PPV 0.50; kappa 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; kappa 0.44), major depressive disorder (SE 0.71; PPV 0.52; kappa 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; kappa 0.21), and panic disorder (SE 0.71; PPV 0.43; kappa 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care.

Adolescent↗

PubMed1996

Predictors of missed appointments for psychiatric consultations in a primary care clinic.

OBJECTIVE: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. METHODS: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients' interactions with the clinic and the referring clinician. RESULTS: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. CONCLUSIONS: The results suggest that shortening the wait for a psychiatric consultation, reserving consultation for more severe cases, and working to reduce patients' resistance to consultation will reduce the number of missed appointments.

Adolescent↗

PubMed1996

Accidental fatal drug overdoses in New York City: 1990-1992.

This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

Accidents↗

PubMed1996

Evaluation of screens for mental disorders in primary care: methodological issues.

Several brief screens are available to help identify mental disorders in primary care. In choosing among them, an investigator must consider the clinical research setting, the sampling framework, and the strategy used to assess the reliability and validity of the instruments. These issues are considered in the context of the study that revised the Symptom-Driven Diagnostic System for Primary Care (SDDS-PC) for the DSM-IV. The sample size determination strategy used in that study rendered a sample that was large enough to allow for a split-sample approach to data analysis. The screen algorithms were developed on an index sample, and the operating characteristics were cross-validated with data from a separate sample. Standard operating characteristics as well as chance-corrected, or quality operating characteristics were used to evaluate the construct validity of the screens. Criterion-related validity of the screens was evaluated by examining functional impairment. Screens such as these may be valuable clinical and research tools for psychiatric diagnosis in primary care.

Humans↗

PubMed1995

Fatal injuries after cocaine use as a leading cause of death among young adults in New York City.

BACKGROUND: Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries. METHODS: Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause. RESULTS: Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City. CONCLUSIONS: Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

Adolescent↗

PubMed1995

More reliable outcome measures can reduce sample size requirements.

In the design of a clinical trial, considerations of statistical power primarily involve the evaluation of prospective sample sizes. Another strategy for increasing statistical power that is rarely used focuses on the selection of the outcome measure. When an outcome measure is selected, its reliability and validity must be carefully evaluated. Here the relationship between reliability and statistical power is explored empirically. We show that as the number of related items in an outcome scale increases, the internal consistency reliability of the scale also increases. As a consequence, the within-group variability decreases and, in turn, the between-group effect size increases and sample size requirements decrease. As a result, sample size requirements can be reduced and research costs decreased. We recommend careful consideration of the psychometric properties of outcome measures prior to sample size determination in any statistical power analyses.

Alprazolam↗

PubMed1995

Use of prescription psychotropic drugs among suicide victims in New York City.

OBJECTIVE: The authors examined the rate of prescription psychotropic drug use among suicide victims at the time of their death. METHOD: From a total of 1,970 suicides that occurred in New York City from 1990 to 1992, 1,635 cases that had a complete toxicologic analysis and an injury-death interval of 48 hours or less were assessed at autopsy for the presence of commonly prescribed antidepressants and neuroleptics. RESULTS: Prescription psychotropic medications were detected in only 16.4% (N = 268) of the suicide victims studied. Demographic factors associated with use of these drugs included female gender and white race. Poisoning accounted for 17.9% (N = 293) of all suicides studied, but antidepressants or neuroleptics were detected in less than half of these victims. Among all suicide victims in whom an antidepressant or neuroleptic was detected, almost half had used lethal methods other than poisoning. CONCLUSIONS: In this study, most individuals who committed suicide in New York City were not taking prescription psychotropic medications at the time of their death and either were not receiving pharmacotherapy or were noncompliant.

Adult↗

PubMed1995

Cocaine, opiates, and ethanol in homicides in New York City: 1990 and 1991.

Studies using medical examiner cases are useful in monitoring drug use in special populations. This study assesses the presence of cocaine and its metabolite, benzoylecgonine (BE), opiates and ethanol in all homicide victims who were injured and who survived two hours or less after injury in 1990 and 1991 in New York City. There were 2824 homicides in the study period and cocaine and/or BE were found in 884 (31.3%) of cases. In over half of the cases positive for cocaine/BE, ethanol or opiates were found. African-Americans and Latinos were much more likely than whites or Asians to be positive for cocaine/BE. There were no differences between men and women in regard to being positive for cocaine/BE. Cocaine/BE was most frequently identified among victims 25 to 44 years of age. Males were more likely to be positive for ethanol. There were no differences among age groups or ethnic groups in regard to ethanol except for a very low ethanol incidence among Asians. Victims positive for cocaine/BE were more likely to be killed with firearms in open places. The percentage of victims positive for cocaine/BE remains approximately that found by other studies in the late 1980s, however, the percentage of opiate-positive homicides seems to be increasing. Opiates usually were found with cocaine/BE. Two-thirds of the cocaine and/or BE positive cases had cocaine present, thus they were under the influence of the drug at the time they were injured. The authors discuss how the use of cocaine, ethanol and opiates may be related to one's becoming a homicide victim.

Adolescent↗